WillySenior Contributor
Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.
CBT-p offers a drug free intervention for people suffering from psychotic mental illnesses such as bipolar disorder and schizophrenia.
Two and a half years ago I made a post on this forum explaining a little about CBT-p and asking for help in finding a suitable practitioner. Rather than repeating this information, here is a link to that post.
The situation since seems to have changed very little. Many people seem to think that CBT-p is a good idea for people suffering from psychotic mental illness but there appears to be little or no competent resources available in Australia. By comparison, CBT-p is readily available in the UK under their national health scheme.
A couple of years ago, JJMary responded to my original CBT-p post on this forum with the following-
“Perhaps you might find it useful to do an online course on it yourself, in a way of self-help understanding? There is an inexpensive one at https://www.udemy.com/.”
I undertook this online course consisting of about 5 and half hours of video lectures plus some power point slides and references. It cost me about $20 and was money well spent. The tutor, Ron Ungar, in my opinion, appears to be a knowledgeable expert in this field.
His blog https://recoveryfromschizophrenia.org/ provides insight into some different aspects and ideas about non pharmaceutical treatment of psychosis.
Even the best of courses only provide information, not treatment. Using this information to try and fix oneself could be likened to do-it-yourself brain surgery. Input from a skilled therapist would seem to be essential in any form of CBT-p service.
I have also been in contact with Eastern Melbourne, Primary Health Network (EMPHN). I was referred to these people as a source of information about CBT-p providers. EMPHN are a federal government body. I think it is important to differentiate between state and federal government organisations when looking at these sorts of things because there are substantial differences in attitudes and policies between them. I have observed this first hand in Victoria where I live. It seems to me that nearly all innovation and development in mental health treatment that has taken place in Australia in recent years has been done at the Federal government level. At the state level it would seems that there is often antagonism to anything that challenges the conservative biomedical model and the pharmacological treatment of mental illness.
Here is an extract from the most recent response from EMPHN
“You are correct in noting that CBT based therapies and principles have been shown to be effective for a range of mental health conditions, including psychosis. Like most options available to assist with our wellbeing, it is often beneficial to implement a range of treatment strategies as there is no single intervention to fit all circumstances or experiences.
Your question around readily available clinicians with specific CBT for psychosis training is difficult to answer as there are courses and formal training available to clinicians in Australia. Perhaps it’s an area that not many clinicians seek training in or perhaps feel they can adapt their CBT principles in practice to an individual’s circumstance regardless of their diagnosis
If you are looking for support for yourself, the Australia Psychological Society website has a directory of all Psychologists registered in Australia and you are able to search by location and area of expertise, psychosis being one of the search parameters. This may provide an avenue to find clinicians who work with people experiencing psychosis to enquire what principles or therapies they utilise
Please let us know if we can be of further support or guidance.” etc
Some time ago I went through the directory of the Australia Psychological Society and various other online resources. I found a handful of people who claimed expertise in CBT-p and I have communicated with a number of them. What I discovered was that while they may well have completed some theoretical training in CBT-p they invariably have no practical experience and are therefore understandably reluctant to get involved with anybody who is prone to psychosis.
While CBT-p is based on traditional CBT, there are significant differences. Not only does it involve the knowledge and use of some interesting additional techniques but also good clinical and interpersonal skills are required in order to work safely and effectively with people prone to psychosis. These skills can be learnt. From my own experiences, the well trained volunteer Lifeline councillors have these skills but quite a few other mental health practitioners that I have come across do not.
The initial aim of CBT-p is not to replace drug therapy but rather to work along side it if and as required. It can also offer a viable alternative to drug therapy for those who want it. In other words it provides a choice which in my experience, people in Australia with serious mental illness have seldom had. Any reduction in the existing use of anti-psychotic medication is likely to occur slowly as people who are prone to psychotic episodes become more functional. For many, that in itself would be a very worthwhile goal. CBT-p often seems to be more about managing symptoms rather that trying to prevent or suppress them. It is therefore a very different approach to the biomedical model that typically uses anti-psychotic drugs to try to suppress symptoms. For example, in recent years it has been discovered that many people who have no history of psychosis, experience phenomena such as auditory hallucinations (hearing voices) and are able to integrate these experiences into their normal everyday lives.
Hopefully over time, the use of CBT-p practices, would enable some people to become totally drug free and fully functional.
CBT-p is not without its problems and limitations. One of its biggest limitations is that it requires many hours of regular effort over a sustained period of time. For many people with psychotic illnesses who are stabilised on medication, just being able to get out of bed in the morning, shower and take a walk around the block can represent a significant days accomplishment.
A CBT-p intervention is therefore likely to be a slow and challenging process for many, particularly in the beginning but there are numerous ways in which it can probably be made easier by building incentives and motivation into a program.
The Covid lockdowns have shown that conventional CBT can be delivered as effectively online as with face to face counselling. There seems to me no reason why CBT-p can’t be delivered in a somewhat similar way, possibly using some sort of hybrid approach. If well thought through, this approach could substantially reduce delivery costs compared to face to face arrangements.
According to Federal government statistics, about 20% of Australians suffer from mental illness in any one year. This is obviously a huge problem. By contrast only about 0.5% of Australians suffer from psychotic mental illness. This much smaller number of about 125,000 people, together with the common myth that these conditions are incurable is probably the reason why psychotic illnesses have all but been ignored except for pharmaceutical treatment.
The cost of psychotic illness however, which is mostly born by the Federal government is anything but trivial. My back-of-envelope calculation puts this cost at around $10 billion per year.
By comparison, the cost of setting up and operating a national online CBT-p program would be trivial. Even it it reduces current support costs by only a small amount, it is hard to see how it wouldn’t be a profitable proposition for government. In an ideal world, reducing human suffering should be free of monetary considerations but if it can be achieved at the same time as significant savings in mental health care costs, this would appear to be a windfall.
A project like this needs the sponsorship of an organisation like SANE to get behind it and solicit support from the Federal government. The next step after that would be to engage the support and expertise of the psychology departments of one or more Universities. Some Australian Universities have already demonstrated their skills in this area with successful online CBT projects like e-couch , Moodgym, ThisWayUp etc.
I would be more than willing to participate as a shared experience user in the development of such a program. I expect that there would also be a ready supply of other volunteers from the 125,000 Australians suffering from psychotic mental illness.
A CBT-p service would be a significant step upwards in online mental health service delivery in Australia. It is obviously quite achievable. With a little bit of thoughtful innovation an organisation like SANE Australia could well become a world leader in CBT-p best practices.
There is much more I could say on this subject but this post is already getting quite lengthy so I will leave it here and see what interest and feedback follows.
Regards
Willy
